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Long-Term Care

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Tips for Buying Long-Term Care Insurance
By Mary Damiano

(Page 2 of 3)

  • Who decides when you’re eligible benefits? Insurance companies have different criteria for paying benefits. Some require only a doctor’s order. Others base their coverage on the policyholder’s ability to perform everyday tasks such as bathing, dressing and feeding themselves. These tasks are called Activities of Daily Living, or ADLs. When an insurance company uses ADLs as a guideline, the difference between someone being able to perform these tasks with physical assistance, supervised assistance can mean the difference between eligibility and ineligibility.
  • Does the policy evaluate mental functions when deciding eligibility? A person with Alzheimer’s may be physically capable of performing ADLs, yet they might forget where they live and wander off or forget to take medications. Unless the policy states that they take mental functioning into consideration, the policyholder with Alzheimer’s disease may be denied coverage.
  • Does the policy require that in order to qualify for benefits, the policyholder needs “one on one continual assistance”? This is a very restrictive requirement and one that is difficult to meet.
  • Does the policy clearly explain claim-filing procedures and the policyholder’s rights to appeal decisions made by the company? It is very important that you understand exactly what you must do in order to get your benefits.
  • Have you done a personal inventory of your income and assets? This is important to see not only if you will be able to afford the policy over an extended amount of time, but also how much you can afford in out-of-pocket expenses.
  • Have you answered all medical questions truthfully? When you get a policy, companies usually ask some medical questions and some even ask for a statement regarding your health from your doctor. The company wants to make sure you’re a good risk. When you file a claim. However, the company may look for reasons to not pay that claim, so they go over your medical history with a fine tooth comb. If they discover you were misleading about your health, claims can be denied. No matter what the insurance agent says, make as a full disclosure about your medical history. If you can’t remember much, refer the company to the doctor who treated you. If you’re really not sure about something, legally speaking, “I do not recall” is a much safer answer than “I don’t know.”



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